Spring 2015 JVS/CCSF Nursing Refresher Program Application

Background JVS in collaboration with the City College of San Francisco (CCSF) offers a 17-week, 4 day/week training program for Licensed Vocational or Registered Nurses, trained either in the United States or abroad, who need a refresher course or want a nursing skills brush-up to re-enter the nursing field. This successful 22-year program is offered in collaboration between JVS, CCSF’s Vocational Nursing Program, and local medical facilities.

The program will include  Over 450 total hours of theoretical, skills lab, & clinical practice experience at CCSF and 2 local medical facilities  General support in completing the course (individualized coaching & referral to resources)  20 hours of job search, interviewing, online application instruction at CCSF  Job search/placement assistance – we’ll help you get your first or next Nurse Job!

Application Process This is a rolling application process and all candidates who meet the eligibility requirements will be considered for the program. Applicants must submit their application by the application deadline: November 1, 2014. JVS may offer more than one Nurse Refresher program; applicants may apply to only one of the offerings.

Program Eligibility Advisories  Must possess and submit proof of LVN or RN U.S. nursing license  If native English speaker, a score placing applicant in English 92 on CCSF English placement test, or provide a copy of U.S. nurse diploma  If a non-native English speaker, a score placing applicant in ESL 150 on the CCSF ESL placement test  Valid authorization to work in the U.S.  Must have been out of the field of nursing in any setting for at least one year  Valid American Heart Association CPR certification (will be required upon acceptance in the course)  Ability to provide clear and current medical exams and immunization records (will be required upon acceptance in the course)  Ability to pass a criminal background check, drug screen (will be required upon acceptance in the course)

Commitment  Full participation in both educational and job search components of the program  Open communication with JVS staff and CCSF for 1 year after you are placed in an LVN or RN job

Class Schedule

Nursing Refresher course will run from January 20 – May 19, 2015.

(First 3 weeks all spent in classroom at CCSF).

Monday Tuesday Wednesday Thursday Dates 1/20-2/05/15 3:00–8:30pm 3:00–8:30pm 3:00–8:30pm 3:00–8:30pm

Dates Monday Tuesday Wednesday Thursday 2/09-5/16/15 12:30-7:00pm 6:45am- 6:45am- 12:30–7:00pm 3:00pm/2:00– 3:00pm/2:00– Dates 10:30 * 10:30* 3/09 – 5/16/15 Monday 10:00 am-noon (20 hours of job search practice: resume, online applications interviewing, networking)

* indicates time in clinical assignment. Clinical rotation at Laguna Honda Hospital is 6:45am-3:00pm Clinical rotation at San Francisco General is 2:00pm-10:30pm. Each rotation lasts 7 weeks.

Starting Feb. 10, 2015, full class of 20 students will be split in 2 groups of 10; one group going to SFGH and the other going to LHH. In 7 weeks, these 2 groups will switch, each group rotating to the other site.

Cost The cost of the program to the participant will be between $100 and $300 for stethoscope, physical examination and immunizations*, background check/drug screen*, and other supplies/materials as needed. You must calculate and cover your own transportation costs.

*You will need a physical examination and immunization record completed by a medical provider in order to take this course. You will also need to pass a criminal background check/drug screen. (The health screen and background check forms will be provided to you later in the application process by the JVS Program Coordinator. These forms and CPR cards MUST be completed and turned in to JVS Coordinator by 12/01/14.)

Please submit complete applications to: Nursing Refresher Program Attn: Django Rampley 225 Bush St. Suite #400

Page 2 of 9 San Francisco, CA 94104 Phone (415) 782-6267 Fax (415) 391-3617 [email protected] SPRING 2015 APPLICATION FORM

Please complete this application in full and provide all required documentation

Applicant Information

First Name:______Last Name: ______

Street Address: ______

City, State: ______

Zip Code: ______

Home Phone: ______

Cell phone: ______Fax: ______

Email Address: ______

Date of arrival in the U.S. (if applicable): ______

Primary languages spoken:______

Are you currently or have you ever been a JVS client? ______

If so, who was your main contact at JVS? ______

How did you hear about this course? ______

Have you ever been enrolled at CCSF? Yes No If Yes, When? ______

Under what name?______

Have you ever applied to a Nurse Refresher course before?

☐ Yes When? ______Where? ______

☐ No

Have you ever participated in a Nurse Refresher or re-entry course before?

☐ Yes When? ______Where? ______

Page 3 of 9 ☐ No

Page 4 of 9 Part 1: Education and Training

What was the name of your nursing school? Where was it located?

______

What year did you graduate? ______

How long was the program? ______

What U.S. nursing licenses do you have? ______

If you have a U.S. LVN or RN license, is it currently active, expired, or inactive? ______

If expired, where are you in the process of up-dating it? ______

If inactive, where are you in the process of reactivating it? ______

If expired or inactive, when do you anticipate your license will be valid/active again? Click here to enter text.

Have you ever participated in a nursing program in the U.S or received any other training beyond a basic nursing program? If yes, please describe.

Page 5 of 9 Part 2: Nursing Work Experience

Please describe in detail your professional nursing experience both in the U.S. and in your native country, if applicable. Include your positions, years and areas of work (e.g. medical/surgical, pediatrics, operating room, skilled nursing, clinic, etc.). What are your career goals? You may use a separate sheet if necessary.

Are you employed now? ☐ Yes ☐ No

Page 6 of 9 Part 3: Personal Statement

Why do you want to enter this program? What would you like to gain from the Nursing Refresher Course? What would you like the Nursing Refresher Course staff to know about you? You may use a separate sheet if necessary.

Page 7 of 9 Part 4: Supplemental Intake Questionnaire

Section A – Work and School Load

1. How many hours per week are you currently working or attending school? ______

2. Do you plan on changing or reducing your work or school hours when the Nursing Refresher program begins?

☐ Yes ☐ No ☐ Maybe (Please Explain)

3. Have you talked to your employer about applying for this program?

☐ Yes ☐ No

4. How many hours per week do you plan to work while participating in the program? ______

Section B – Family Responsibilities

1. Do you have children below the age of 18 or an adult you must care for?

 Yes  No

2. If yes, how many? ______

3. Do you have help with the care of your children or adult? ______

Section C – Transportation

1. How do you plan to get to class, and how long do you estimate it will take you? ______

2. How do you plan to get to the clinical sites, and how long do you estimate it will take you? ______

Page 8 of 9 Application Checklist

Required documents (please give to JVS coordinator):  Completed JVS application form – Due by 11/01/14  Copy of CA LVN or RN nursing license – Due by 11/01/14  Nurse resume – Due by 11/01/14  CCSF ESL placement test results (150 or higher)* (required if English is not your primary language) – Due by 12/01/14  CCSF English placement test results (English 92 or higher)* or a copy of U.S. Nursing diploma - Due by 12/01/14

Optional documents:  Copy of nursing transcripts - Due by 12/01/14

If you are eligible, have submitted all of the required documents, and are selected to move forward with the application process, you will:

 Interview with the JVS Nursing Refresher Program Coordinator  Have a final interview with the CCSF Nursing Refresher Course Lead Instructor

Upon acceptance into the program, you will be required to provide the following to JVS staff by Dec. 15, 2014:  A completed physical examination and immunization record completed by a medical provider  Background check/drug screen results  American Heart Association BLS for Healthcare Providers (CPR) valid through May 16, 2015.

* Notes about the CCSF English and ESL placement tests:  Every applicant who speaks English as a second language will have to take the CCSF for credit ESL placement test.  Test results from other schools or the TOEFL will not be accepted.  For a schedule of test dates call 415-239-3128 (or 415-239-3124), or check the CCSF Orientation & Placement Testing web-site at: http://www.ccsf.edu/NEW/ccsf/en/future- students/future-credit-students/take_a_placementtest.html - Under “Placement Testing Schedules” heading click on “ESL (English as a Second Language)” for testing schedules.  Every applicant who speaks English as their native language will have to take the CCSF for credit English placement test, or show completion of college level English course by providing a copy of their U.S. Nurse diploma or transcripts.  For a schedule of test dates call 415-239-3128 (or 415- 239-3124), or check the CCSF Orientation & Placement Testing web-site at: http://www.ccsf.edu/NEW/ccsf/en/future- students/future-credit-students/take_a_placementtest.html - Under “Placement Testing Schedules” heading click on “Native English testing)” for testing schedules. You do need to take the Math placement test.

Please submit complete applications via email (preferred), fax or U.S. mail to:

Nursing Refresher Program Attn: Django Rampley 225 Bush St., Suite #400 San Francisco, CA 94104 Phone (415) 782-6267 | Email [email protected] | Fax (415) 391-3617 Page 8 of 9